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HomeMy WebLinkAboutBLD2014-00041 •UILDING PERMIT APPLICA•N BLDI4-00041 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00041 Received Date: 1/31/2014 SITE ADDRESS: 95 W LUDLOW POINT RD PORT LUDLOW, 98365 OWNER: DELBERT H JACOBS TRUSTEE PHONE: 3605310927 SHIRLEY G JACOBS TRUSTEE 95 W LUDLOW POINT RD PORT LUDLOW WA 98365-8786 LUDLOW POINT VILLAGE DIV 1 SUBDIVISION: Block: Lot: PARCEL NUMBER: 969400025 Section: 17 Township: 28 N Range: 01 E CONTRACTOR: BRENNAN HTG &A/C LLC PHONE: 206-248-7900 4601 S 134TH PL SEATTLE WA 98168 Contractor's License BRENNHA971R9 Expires 12/29/2015 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIO1 Replace air handler and heat pump TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $152.00 JLA 01/31/14 145820 APPROVED Total: $152.00 V Jefferson County DCIE \\4ir7nmorlArlofo\fnrme 1I= PI fl Ann PI1 rn+ 1/Q1/')f11A . ri - • . • JEH ERSO COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT ` 621 Sheridan Street•Port Townsend"Washington 98368 CFI • , : 360/379-4450. 360/379-4451 Fax www.co.jefferson.wauskrommdeveloprnent us/commdevelopment Master Permit Application MLA: old / 1/I Project Deription(include •.: :,-sheets as necessary): La • t -4i i `, ` r- fei A., --k•- A .' & &LA° Tax Parcel Number. '1 _ [ 4147.! 5 Property Size: (acxesfsquare feet) Site Address and/or to Prope Property r(s)of Record• 1 V 1 Telephone: ' 2)t Fax: email: Appiicrertt/Agent(if different`�� 0. ' Mailing Address: from owner): I f?. r A .a, -4 __ 1.a. t A d: Telephoner Ol,c. `rN Qi . Fax:._ E . .. t. 1 DJ email: 11i I .ia .' Mailing Address: t hit--1'I 1 . Con What kind of Permit?',Check each box that applies OBuiiding ❑Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use) mingle Family 0 Garage Attached/Detached ❑Conditional Use IC(a),C(d),or CI** O Manufactured Home ❑ Modular ❑Discretionary"D*or Unnamed Use Classification ❑ Commercial' ❑Special Use(Essential •• • IV,•:I' I;- .. ❑ Change of Use D Boundary Line Adj , � . C [ g V L-o Road Approach 0 Short Pmt ' 1 I 1 D o Cottage Industry ❑Bindg Site Plan** ❑Propane 0 Long Plat** ❑Sign ❑Pinned Rural R . _ • ( D) ndmpl is ❑Allowed`Yes'Use Consistency Analysis 0 Plat Vacation/Alteratio N 1 . ❑Stormwater Management ❑Shoreline Master Prog =, • • •,• • Revisions** O Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline M- ••:••- -. Su• P77: ; :,iilTy . ❑Temporary Use ❑Shoreline Mana.,- Variafir, i F Cr A lit IPI 1 n^;I ❑Wireless Telecommunication* D Comprehensive Pla • - *_ . :.•, • .• ❑Forest Practices Ad/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pm—Application Conference 0 Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal,if known: • DSIG ATION OF AGENT I hereby designate �A�� 1 -11''11 to act my agent in matters r ng to this application for permit(s). OWNER SIGNATURE 32---9— Ul Jill/ 1(, p o O : By signing this application form,the owner/agent attests that the Information provided herein,and In any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,Indemnify and hold harmless Jefferson County against all Hablities,Judgments,court costs,reasonable attomey's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further ag - provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review a • : -.uired later inspections. access and right of entry will be assurled unless the:•• «- informs,*le Gouty in writing at the time of, thathe or she wants r. lice. Signature: - ■L A L r Date: 1 The action a_ctionsApplicant wilt undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take'of an endangered species as those terms are defined in the federal law known as the `Endangered Species Act"3r'ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this. permit has._- . - _.wilt not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)= if • are in compliance with the . County development code.The Applicant acknowledges that he, or it holds individual and no • pa�sb for adhering ,.•complying with theffSt. The Applicant has read this d' dates i below. Signature: Date: 1 G:\PennitCenar\###FO \DRD FORMS-Vaster Permit Application 5-29-0840c • • BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herekl,that they are not licensed contractors and th at they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Dom: `ENERAL CONTRACTOR OR UFACTURED HOME INSTALLER: PHONE: FAX: ,k .. 0.111 1.- . ,_ t cap a i t coke Gi t al 5 NnLN;AoaRESS:y r ° � 1i , �.: .. . . . `, CONTRACTOR'S LICENSE bi,eANX\ t, f —A.A. I $ ! it( INS Co cy- NuMsEIt: NUMBER ARCHRECT/ENGINEER: P ( ) FAX: MAILING ADDRESS: ' EMAL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: o New ❑ Wood Existing: ❑Sewer ❑ !ddItion ❑ Steel Proposed: Bank ❑ Commundy System he Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit It ❑ Demolition ❑ OtO Bedrooms: Water Supply: Existing: Setback: o Private well ❑ Two Party Type of Heat Proposed: 0 Public el e C Total: Name of System: 1 ' If this is a Commercial Protect you must answer the followina: Number of Parking Spaces: Current: Proposed: Number of A©A Parking Spaces: Number of occupants('includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes No if this is a Propane Tank andlor Appliance Installation permit.marital!Items below that apply: 1 Underground Tank 1 Above ground Tank Size of Propane Tank: I Heat Stove I Cook 1 Woodstove 1 Fireplace Insert I Hot Water Tank I Pellet Stove I Other Is this appliance bein installed in a Manufactured 1 Mobile Home? Yes / No When applying fora P�k to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location anld size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Main Floor Heated $;Fyn , EH Bid App Review: 2"°Floor Heated Consistency Review: Other Heated -'' :` ' Base fee: Mezzanine Additional Section: T� i --� Plan Check fee: rat 4-- Iw ►1, � liii . : - - l/��r Surchargef e: �rl���nh- 12�` �, ;` Pot Water Review fee: c�'f":7.'_Carport Pu SUBTOTAL DC INN 911/Rd Approach fee:. n�F QSNU ' Other TOTAL: $ Receipt Number: L" , CashlCheck Number: ESTIMATED COST(REQUIRED) �' p, Date: •Fair market value of all labor and ma • ish Initials: • G:\Pen itCenoar\###FORMS###WRD FORhIS\MasterPamir Apps 5-29-08.doc 1 . t ....A.my irmurikAi 0 .4.4741...tim.:_ei4i7Aho...._.246.__ 7900 ii- Al 1 11 ,,' 'H i ,,1 ir,;FdlitirXIG wvatbrovvvilisdkc.axn 4AME t1rl.�_3.c sa. HOME PHONE Z DATE_�#141------ WOREBS �36e 3 •• WORK PHONE REPO _ Hr 3 ., • 43,• v7 'V ZIP CODE COSTCO STORE 0 Ae0-T• t..rlfcow a?$3+63' t 3 EXISTING ..,, ____ _ II1ECEIVFTM LOCATION _ ILIfi 11111 GAS LINE in JAN 3 1 1 1111 VENTING 6 6 lVi ELECTRICAL EFFER ON �,;�• GENERAL DESCRIPTION Ca iti sour.•..tr�... Iws ,4241. the ft Jt eol, r oavvou"6 cid, OF WORK /ti s •-4, 4,440.. 4 ei,It Co 40t j1oA,c�#-s (-0 ,�3 fr.raw a t....+ TO BE DONE 'c6.e. 0 cc / ,4- 14 s 0t►-4+► 4 4c I .►dte'Si 444.-44,4+.4, ANWe."E— si.,r.i-.... ., C-' ems- 1/'c •• • tom' ‘''� - CUSTOMER tt433 v 4 caiq3X-t►v 4 TO PROVIDE , it?t•4 ,ePi , _� . $ $ $ U S,�-�"� ✓ EC;i .,�/ iri Cda $ $ $ i EXTENDED WARRANTY iryela,,,r tea $ EMERGENCY EARTHQUAKE SHUT-OFF . city... $ 77. Z 70 ELECTRONIC AIR CLEANER $ SOWER DUCT CLEANING $ .. , SUB-TOTAL $ s - - 0 —, 115 — /,6./ TAX $ f$''Q = t•01 tM TOTAL $ I I c-?7 . t Z S`114-14,J . We Propose howdy to t o r n a d o m o t o t i i l i and labor. .. • : In ioeiMinoo Mw ibovo emedia M graanwat Is be M Wee&M womb b 4 be eowellese in a MbMYMNf ef�ow r sa MMrawrilm ewMedy 08116 apyMMt law inMeeraa Aa 6::=1 N irw iwbM� !=M ap�Lw ea e ween "r M L "e '� ev a Mi* wndM Weems enobee1M�eaw miaow Msinee warm kr MAO veatteryuN HOC bede. 1i V' D Flu .•,* �1 :coptonoo of Proposal __ 4i, MNM/MsNenrw/wbMM �adpaelbaM popul.i i 1p jprI- _AeitieudnNlNMiMewprwwekrele 4 cemeeerwsM Hebeweeme, wee: NaLti,„,74Beigie . • 1 C(e7 Clc‘.A4 i I e w_ 0 ut V �Q ∎`� l l ,, v A, -:,,, , ..,1,/ 4. .,. , , , h a / bq V e\ � b z Q 3 v' Q rCEVE I JAN 1 2014 JEFF' SON COUNTY DEPT OF :MMUNITYDEVELOPMENT t, W .Pala‘N r (VN Screen: 01 REAL PROPERTY MASTER Mode: INQUIRY Parcel # 000969400025 Illo Cd 282117407231 • Auto Roll : OFF LUDLOW POINT VILLAGE DIV 1 Nbhd Cd 3345 LOT 25 Loc ID * Taxpayer Cd JACO 0340 JACOBS TRUSTEE, DELBERT H T/P Chg Dt 7/21/1994 * Title Owner T/P Chg Usr KELL Tax Code 0231 Status TX TAXABLE Land Use 1100 RES-SINGLE Affidavit 74643 Vol/Page / C/U Code COMPLETE ADDRESS WINDOW Taxpayer JAC00340 DELBERT H JACOBS TRUSTEE SHIRLEY G JACOBS TRUSTEE JACOBS FAMILY TRUST 95 W LUDLOW POINT RD PORT LUDLOW WA 98365-8786 Search Key CMD 6: End Window CMD 7: End of Job BRENNAN HEATING& A/C LLC Page 1 of 2 CoWashington State Depat tunent If Labor & Industries BRENNAN HEATING & A/C LLC Owner or tradesperson 4601 S 134TH PL ERDAHL, DARRIN PAUL SEATTLE, WA98168 206-248-7900 Principals KING, County ERDAHL, DARRIN PAUL Doing business as BRENNAN HEATING&A/C LLC WA UBI No. Business type 602 346 866 Limited Liability Company Governing persons DARRINPERDAHL License Verify the contractor's active registration/license/certification (depending on trade) and any past violations. Construction Contractor Active. Meets current requirements. License specialties GENERAL License no. BRENNHA971R9 Effective—expiration 12/29/2003—12/29/2015 Bond ......... FEDERATED MUTUAL INS CO $12,000.00 Bond account no. 9127230 Received by L&I Effective date 11/04/2004 12/22/2004 Insurance Federated Mutual Ins Co $1,000,000.00 Policy no. 9820726 Received by L&I Effective date 06/10/2013 07/13/2007 Expiration date 07/13/2014 Savings No savings accounts during the previous 6 year period. https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602346866&LIC=BRENNHA971R9&SAW= 1/31/2014 BRENNAN HEATING& A/C LLC Page 2 of 2 Lawsuits against the bond or savin. ID No lawsuits against the bond or savings during the previous 6 year period. Tax debts No tax debts during the previous 6 year period. License Violations Infraction no. PPEJP00330 Satisfied Violation date RCW 09/14/2012 18.106.020 Violation city Violation amount Seattle $250.00 Type of violation PLUMBER INFRACTION Workers' comp Do you know if the business has employees? If so, verify the business is up-to-date on workers' comp premiums. L&I Account ID Account is current. 803,761-08 Doing business as BRENNAN HEATING&AIR CONDIT Estimated workers reported Quarter 3 of Year 2013"76 to 100 Workers" L&I account representative T1 /FEARAED FEROZE(360)902-4797 -Email: FERH235@lni.wa.gov Workplace safety and health No inspections during the previous 6 year period. ©Washington State Dept.of Labor&Industries. Use of this site is subject to the laws of the state of Washington. Acceu Washington https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602346866&LIC=BRENNHA971R9&SAW= 1/31/2014 MECHANICAL AND DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD14-00041 Received Date 1/31/2014 SITE ADDRESS: 95 W LUDLOW POINT RD Issue Date 1/31/2014 PORT LUDLOW, 98365 APPLICANT: DELBERT H JACOBS TRUSTEE PHONE: 3605310927 SHIRLEY G JACOBS TRUSTEE 95 W LUDLOW POINT RD PORT LUDLOW WA 98365-8786 SUBDIVISION: LUDLOW POINT VILLAGE DIV 1 Block: Lot: PARCEL NUMBER: 969400025 Section: 17 Township: 28N Range: 01E CONTRACTOR: BRENNAN HTG &A/C LLC PHONE: 206-248-7900 4601 S 134TH PL SEATTLE WA 98168 Contractor's License BRENNHA971 R9 Expires 12/29/2015 OWNER, DELBERT H JACOBS TRUSTEE PHONE: 3605310927 if different: SHIRLEY G JACOBS TRUSTEE 95 W LUDLOW POINT RD PORT LUDLOW WA 98365-8786 PROJECT DESCRIPTION: Replace air handler and heat pump Directions To Site: THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 1/31/2015. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: I/—i'"II-1 541, BUILDING INSPECTION HOT-LINE 379-4455. REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED. Office Hours 9:00 a.m. -4:30 p.m. Monday-Thursday HOT LINE AVAILABLE 24 HOURS A DAY \\tidemark\data\forms\F_BLD_Permit_Propane.rpt 1/31/2014 4 4'4Foce)% JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 9SA 3,0 Date: 1 11h,1i4_ Time Received: I 1 ea m Mon. Tue. W-d. T . /�I Date: i ' BLD: 4—�4 ( Contact Name: gr� MMi,,$ Owner: -z_ . �, A _--_ Contact Number: 360 * — • , 8- Address: �� /, ��– __ Lam :rt Notes: IL:. A.,A A � • .. # i 1 •/ i - / V� \___ Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection X Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling